This proposal is a competing continuation of T32-NR-007104 that began in 1999. The request is for 5 pre- doctoral and 4 post-doctoral trainees. Our proposal is responsive to the Institute of Medicine's recommendation to double the number of nurses with doctoral degrees by 2020. We place high priority on the recruitment of BSN to PhD students, targeting the recruitment of nurses to doctoral study who had not previously decided upon a research career in order to increase the pipeline into PhD education. We have made curriculum changes and organizational adjustments to our mentoring program to enable successful completion of the PhD within 3 years by trainees with and without master's degrees. Our goal is to recruit promising young nurses into research careers and make it feasible for them to complete their training by age 30 thus enabling them to make sustained contributions to nursing science, improved clinical care, and education of the next generation of nurses. Ours is a formal interdisciplinary program comprising the conceptual and empirical foundations and cutting edge methodologic approaches and statistical tools of advanced outcomes research and we specialize in identifying and employing large secondary data sources. Our research priorities, reflected in the funded research of our faculty, are improved outcomes for the chronically ill, reducing health disparities, comparative effectiveness of nursing delivery systems, improved care for critically ill patients and end of life care, and outcomes across settings from hospitals to nursing homes to home care. Our curriculum for BSN to PhD research training includes a year-long course in clinical nursing in recognition that many of our high priority applicants do not have the benefit of extended clinical experience and need increased clinical exposure and mentoring in order to ask clinically-relevant research questions. Our students take coursework with our interdisciplinary affiliated faculty and our program interfaces with related training programs throughout Penn providing a network of educational opportunities for trainees that augment their experience. The program is guided conceptually by the Quality Health Outcomes Model postulating that outcomes of nursing interventions are mediated by the organizational context in which care takes place and the health status and characteristics of patients. Trainees receive state of the science education in the measurement of the organizational context of care, patient risk adjustment methods, nurse sensitive outcome measures, spatial geography and geocoding, comparative effectiveness methods, cost of care measurement, panel studies, and international outcomes research. The program's first 14 years have been highly successful in terms of recruitment and program completion including by minorities, high visibility scientific publications by trainees, success of our alumni in competing for grant funds, and the placement of those who have completed their training in mainstream research positions where their research careers can flourish.